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Focal Leptomeningeal Disease with Perivascular Invasion in EGFR-Mutant Non-Small-Cell Lung Cancer
A Dasgupta1, F Y Moraes1, S Rawal1
1From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.
Abstract:
We report a previously undescribed pattern of brain metastases in patients with epidermal growth factor receptor-mutated non-small-cell lung cancer treated with tyrosine kinase inhibitors and radiation therapy. These highly distinct lesions appear to spread focally within the leptomeninges, with invasion along the perivascular spaces (FLIP). The survival of patients with FLIP was significantly better compared with patients with classic leptomeningeal disease (median survival, 21 versus 3 months; P = .003). It is unclear whether this pattern of growth is unique to epidermal growth factor receptor-mutated non-small-cell lung cancer.
Insights
A new pattern of brain metastases, called FLIP, was found in patients with epidermal growth factor receptor-mutated non-small-cell lung cancer. Patients with FLIP showed significantly better survival than those with classic leptomeningeal disease.
Area of Science:
- Neuro-oncology
- Thoracic Oncology
- Molecular Oncology
Background:
- Non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations often metastasizes to the brain.
- Standard treatments like tyrosine kinase inhibitors (TKIs) and radiation therapy can be effective but do not always prevent brain metastases.
- A deeper understanding of metastatic patterns is crucial for improving patient outcomes.
